Open AccessAlignment of health plan coverage policies for somatic multigene panel testing with clinical guidelines in select solid tumors
Author(s) -
William Wong,
Daniele Anina,
Chia-Wei Lin,
Devon V. Adams
Publication year - 2022
Publication title -
personalized medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.489
H-Index - 31
eISSN - 1744-828X
pISSN - 1741-0541
DOI - 10.2217/pme-2021-0174
Subject(s) - guideline , clarity , actuarial science , business , medicine , pathology , biochemistry , chemistry
Aim: Commercial plan coverage policies for multigene panel tests may vary and could result in geographic variation in coverage due to the fragmented nature of the commercial insurance market. This study aimed to characterize the alignment of multigene panel tests coverage policies to that of clinical guidelines, overall and by state. Materials & methods: We reviewed NCCN Guidelines ® for four tumors. Public coverage policies were identified via web search. Payer policies included those with the largest or second largest number of commercial lives in each state. Policies were classified as ‘more restrictive’ or ‘consistent’ with the guidelines. Results: Of 38 plans/policies reviewed, 71% were classified as ‘more restrictive’ than the guidelines, with variation in the number of commercial lives by state. Among these, 52% restricted on panel size and 63% restricted in all or select tumors. Conclusion: Most coverage policies were more restrictive. Clinical guideline clarity and state policies may improve alignment to guidelines and geographic variations.